Adolescent decision making: a broadly based theory and its application to the prevention of early pregnancy

Adolescence, Fall, 1996 by Courtney P. Gordon

INTRODUCTION

The importance of understanding how adolescents make decisions lies in the challenging and difficult problems they face today. For example, unlike their predecessors, some of their decisions may result in being infected with AIDS. If we as adults are to guide adolescents in making decisions, we need to know what information they possess, what information they choose to use, and their cognitive ability.

Many studies of adolescent decision making consider one aspect of the subject, such as the Piagetian stage of cognitive development, social and psychological influences such as peer pressure or risk taking, or ethnic effects such as membership in a minority group. These studies give us individual components of decision making. The purpose of this paper is to develop a broadly based theory of adolescent decision making which includes all the necessary components. This theory is then applied to the decision-making process of female adolescents with respect to early childbearing and illustrates it with data obtained at an inner-city high school.

The need for an encompassing theory becomes obvious when we consider what happens without it. One example is the commonly used approach to the prevention of early childbearing. The assumption is often made that almost all adolescent pregnancies are unintentional and that education about reproduction and contraception will provide the sexually active adolescent with the knowledge he or she will want to use in order to prevent pregnancy. We now know that sex education courses by themselves have had little impact on reducing adolescent pregnancies (Olsen, Jensen, & Greaves, 1991). In reality, knowledge (or lack of knowledge) about reproduction and contraception is just one component which may or may not enter into the adolescent's decision to have intercourse without protection. Adolescent decision making on this subject is a complicated interplay of many variables. For example, for an adolescent female, the combination of low academic achievement leading to a desire to drop out of school, low socioeconomic status, and lack of available jobs may lead to pregnancy as the only reasonable alternative. Such a young woman knows welfare will support her and, most importantly, having a baby will give purpose and meaning to her life. No other acceptable options may be available to her. Pregnancy, in her case, is the desired outcome and is not unintentional. Even as far back as 1976, as many as one third of pregnant adolescents surveyed wanted the pregnancy (Zelnik & Kantner, 1979). Appropriate health care programs intended to defer pregnancy will differ considerably for the sexually active students who do and do not wish pregnancy. The former will need to focus on helping the adolescents develop other alternatives to pregnancy, while the latter needs to focus on contraceptive education and overcoming barriers to using contraceptives.

LITERATURE REVIEW

In the review of the literature which follows, both the factors and the theories involved in adolescent decision making are presented. It is the thesis of this paper that decision making in adolescents depends on a set of factors: cognitive ability, social and psychological development, and cultural and societal influences. The review of the literature is divided into these three major groups of factors.

Cognitive Factors in Adolescent Decision Making

Piaget's theory of concrete versus formal operational thinking. Cognitive factors are taken to mean those which are relevant to the mental process of knowing, including perception and reasoning. Piaget distinguishes between the concrete stage of reasoning typical of an eight- or ten-year-old in which the child concentrates on the immediately present object world, and the formal operational stage of reasoning of adolescents, in which the ability to hypothesize, abstract, and take the future into account develops (Inhelder & Piaget, 1958; see Flavell, 1985, for a summary of Piaget's theory). Three main concepts underlie this theory: concrete versus abstract thinking, present versus future orientation, and consideration of only some options versus all options. As the child matures, the brain becomes able to retain larger amounts of information at once, making it possible to intercompare this information and also to build up bodies of information (Flavell, 1985). Inhelder and Piaget emphasize the centrality of the future orientation of adolescents, stating that, "the adolescent differs from the child above all in that he thinks beyond the present" (p. 339). Urberg and Rosen (1987) confirm the greater future orientation in older as opposed to younger adolescents in making decisions about whether or not to have an abortion. Some researchers question Piaget's thesis that the formal operational stage is normally reached by almost all adolescents (Cobliner, 1974). Others have concluded that only 30% of adults ever reach this final stage (Kuhn, Langer, Kohlberg, & Haan, 1977). It is also possible that the adolescent will use formal reasoning in making some decisions but not in others. Some authors have advocated the teaching of formal operational level decision-making skills for use in reproductive decisions (Gordon, 1990; Sachs, 1986).